Review Chapter 9 slide in module Activity: Examine the five factors to be assessed before delegating (potential for harm, etc.) for a particular

Discussion 2

Review Chapter 9 slide in module

Activity:

Examine the five factors to be assessed before delegating (potential for harm, etc.) for a particular task.

In making a decision to delegate a nursing task, the following five factors should be assessed:

1. Potential for harm: The nurse must determine how much risk the activity carries for an individual patient.

2. Complexity of the task: The more complex the activity, the less desirable it is to delegate.

3. Amount of problem solving and innovation required: If an uncomplicated task requires special attention, adaptation, or an innovative approach, it should not be delegated.

4. Unpredictability of outcome: When a patient’s response to the activity is unknown or unpredictable it is not advisable to delegate that activity.

5. Level of patient interaction: It is not advisable to delegate so many tasks that the amount of time the nurse spends with the patient is decreased to the point that a therapeutic relationship cannot be established between the nurse and the patient. (AACN, 2004Links to an external site., p.10)

Explain why or why not a task would be delegated depending on each factor.

using an example you can share, and/or face at your current practice setting? (I work at a needle exchange program where understaff and delegation has become a big problem as more work has to be divided when staff is already burnout). 

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Chapter 9

Delegation in Nursing

  • Delegation is a fundamental aspect of a nurse’s role
  • Florence Nightingale viewed delegation as a critical skill
  • Delegation issues

Overview of Delegation

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  • Accountability
  • Assignment
  • Authority
  • Client care activities
  • Delegate/delegation
  • Nursing activities
  • Scope of practice
  • Supervision
  • Unlicensed assistive personnel (UAP)

Definitions

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  • Working With Others: A Position Paper: Tools created by NCSBN relating to delegation and the roles of licensed nurses and assistive personnel

Data from NCSBN (2005).

Standards and Guidelines for Delegation

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  • Assess and plan
  • Communicate
  • Surveillance and supervision
  • Evaluation and feedback

Data from NCSBN (2005).

NCSBN Model for Delegation Decision Making

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Potential for harm

Complexity of task

Problem solving and innovation required

Unpredictability of the outcome

Level of patient interaction

Data from American Association of Critical-Care Nurses (2004).

Five Factors to Assess When Making a Decision About Delegating Nursing Tasks

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Right task

Right circumstance

Right person

Right direction and communication

Right supervision and evaluation

Five Rights of Delegation

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  • Prepared to receive delegation
  • Participate in communication/information exchange
  • Accept the delegated task
  • Seek clarification
  • Request additional training/supervision (if needed)
  • Confirm expectations/plan of care

UAP’s Role in Delegation

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  • Organizational and legal guidelines and policies
  • Patient safety and accountability
  • Knowledge and education

Three Organizational Principles of Delegation

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  • Nurses use ongoing assessment to prioritize patient needs
  • Prioritization is a non-sequential decision-making process that is ongoing

Prioritization

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  • Addressing imminent clinical concerns
  • High uncertainty activities
  • Significant, core clinical caregiving and managing pain
  • Relationship management
  • Documenting
  • Helping others and patient support
  • System improvement and cleaning/preparing supplies
  • Personal breaks and social interactions

Prioritization Hierarchy

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  • Status
  • Risk to patient and organization
  • Lack of time
  • Lack of trust in UAP
  • Compromised self-esteem
  • Lack of understanding of delegation
  • Leadership style

Delegation Barriers

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Data from Keogh, K. (2014). Lecturer says delegation should be a part of preregistration courses. Nursing Standard, 29(1), 9. doi:10.7748/ns.29.1.9.s7)

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  • Mutual respect
  • Feedback
  • Supervision
  • Communication

Solutions to Delegation Barriers

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  • Nurse must know state’s nurse practice act/organization’s policies/procedures/competencies
  • Practice acts defines activities only nurse can perform
  • Nurse monitors UAP to ensure not acting beyond scope of practice

Scope of Practice

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  • Under law, nurses are not permitted to passively observe substandard care
  • Safety and ethical concerns must be reported to management

Substandard Care

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  • Budget constraints versus safe staffing
  • Inadequate staffing is not a legal defense for inappropriate delegation

Cost Containment

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  • When UAP accepts task then they shoulder some responsibility, but nurse is still held accountable
  • Nurse is obligated to answer for own actions, including supervision

Accountability

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  • Direct versus indirect delegation
  • Communication
  • What to do when in doubt

Other Delegation Issues

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  • Provide delegation education to staff
  • Coach staff in use of delegation
  • Use TeamSTEPPS to mitigate problems

Nurse Leadership and Delegation

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  • Delegation is result of expanded nurse role versus expanded role is result of delegation
  • Changing health care environments: community-based and ambulatory
  • Escalating shortages of nurses, greater acuity of patient illnesses, technological advances, and increased complexity of therapies contribute to today’s current chaotic and multifaceted health care

Current Issues and Trends

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The five rights of delegation include all of the following except:

Right task

Right circumstance

Right person

Right time

Question #1

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Correct answer: d

Rationale: The five rights of delegation include right task (element of care), right circumstance, right person, right direction/communication, and right supervision and evaluation. The right time is not included in the five rights of delegation.

Level: Comprehension

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